<!DOCTYPE html>
<html lang="zh">
<head>
    <meta charset="UTF-8">
    <meta http-equiv="X-UA-Compatible" content="IE=edge">
    <meta name="viewport" content="width=device-width, initial-scale=1.0">
    <title>Document</title>
    <style>
        .main-table{
            width: 100%;
            height: auto;
        }
        span.blue{
            color: blue;
            font-size: small;
            font-weight: bolder;
        }
        span.red{
            color: red;
        }
        #submit{
            width: 70px;
        } 
        #img-02{
            height: 85px;
        }
        #jiameng{
            font-size: 23px;
        }
    </style>
</head>
<body>
    <form action="#">
        <table border="0" class="main-table">
            <tr>
                <td colspan="2">
                    <img src="../img/apply_1.gif" alt="在线申请">
                </td>
            </tr>
            <tr>
                <td rowspan="2">
                    <img src="../img/apply_2.gif" alt="加盟申请" id="img-02">
                </td>
                <td>
                    <h2 id="jiameng">加盟申请表</h2>
                </td>
            </tr>
            <tr>
                <td>
                    <span class="blue">注:打*为必填项</span>
                </td>
            </tr>
            <tr>
                <td colspan="2">
                    <h3>代理申请基本信息</h3>
                </td>
            </tr>
            <tr>
                <td>
                    申请人姓名 <span class="red">*</span>
                </td>
                <td>
                    <input type="text">
                </td>
            </tr>
            <tr>
                <td>
                    籍贯 <span class="red">*</span>
                </td>
                <td>
                    <select>
                        <option value="null">请选择...</option>
                        <option value="fujian">福建</option>
                    </select>
                    省
                    <select>
                        <option value="null">请选择...</option>
                        <option value="jimei">集美</option>
                        <option value="siming">思明</option>
                    </select>
                    区
                </td>
            </tr>
            <tr>
                <td>
                    性别 <span class="red">*</span>
                </td>
                <td>
                    <input type="radio" id="man" name="sex">
                    <label for="sex">男</label>
                    <input type="radio" id="woman" name="sex">
                    <label for="sex">女</label>
                </td>
            </tr>
            <tr>
                <td>
                    身份证号 <span class="red">*</span>
                </td>
                <td>
                    <input type="text">
                </td>
            </tr>
            <tr>
                <td>
                    联系地址 <span class="red">*</span>
                </td>
                <td>
                    <input type="text">
                </td>
            </tr>
            <tr>
                <td>
                    电话 <span class="red">*</span>
                </td>
                <td>
                    <input type="text">
                </td>
            </tr>
            <tr>
                <td>
                    电子邮箱 <span class="red">*</span>
                </td>
                <td>
                    <input type="text">
                </td>
            </tr>
            <tr>
                <td>
                    加盟地区 <span class="red">*</span>
                </td>
                <td>
                    <input type="text">
                </td>
            </tr>
            <tr>
                <td>
                    你是从哪里了解到我们的?
                </td>
                <td>
                    <input type="checkbox" name="baidu">
                    <label for="baidu">Baidu</label>
                    <input type="checkbox" name="google">
                    <label for="google">Google</label>
                    <input type="checkbox" name="television">
                    <label for="television">电视广告</label>
                    <input type="checkbox" name="newspaper">
                    <label for="newspaper">报刊杂志</label>
                    <input type="checkbox" name="advertise">
                    <label for="advertise">路牌广告</label>
                    <input type="checkbox" name="friend">
                    <label for="friend">朋友介绍</label>
                </td>
            </tr>
            <tr>
                <td></td>
                <td>
                    <input type="checkbox" name="">
                    <label for=""><span class="red">点击查看"Android"项目网上加盟免责声明</span></label>
                    <a href="#"> [点击查看] </a>
                </td>
            </tr>
            <tr>
                <td></td>
                <td >
                    <input type="submit" id="submit">
                </td>
            </tr>
        </table>
    </form>
</body>
</html>